A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions

Hans Hansen, Laxmaiah Manchikanti, Thomas T. Simopoulos, Paul Christo, Sanjeeva Gupta, Howard S. Smith, Haroon Hameed, Steven Cohen

Research output: Contribution to journalArticle

Abstract

Background: The contribution of the sacroiliac joint to low back and lower extremity pain has been a subject of debate with extensive research. It is generally accepted that approximately 10% to 25% of patients with persistent low back pain may have pain arising from the sacroiliac joints. In spite of this, there are currently no definite conservative, interventional, or surgical management options for managing sacroiliac joint pain. In addition, there continue to be significant variations in the application of various techniques as well as a paucity of literature. Study Design: A systematic review of therapeutic sacroiliac joint interventions. Objective: To evaluate the accuracy of therapeutic sacroiliac joint interventions. Methods: The available literature on therapeutic sacroiliac joint interventions in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized trials of interventional techniques and the criteria developed by the Newcastle-Ottawa Scale for observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature published from 1966 through December 2011 that was identified through searches of PubMed and EMBASE, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this systematic review, 56 studies were considered for inclusion. Of these, 45 studies were excluded and a total of 11 studies met inclusion criteria for methodological quality assessment with 6 randomized trials and 5 non-randomized studies. The evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain is fair. The evidence for effectiveness of intraarticular steroid injections is poor. The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is poor. The evidence for effectiveness of conventional radiofrequency neurotomy is poor. The evidence for pulsed radiofrequency is poor. Limitations: The limitations of this systematic review include a paucity of literature on therapeutic interventions, variations in technique, and variable diagnostic standards for sacroiliac joint pain. Conclusions: The evidence was fair in favor of cooled radiofrequency neurotomy and poor for shortterm and long-term relief from intraarticular steroid injections, periarticular injections with steroids or botulin toxin, pulsed radiofrequency, and conventional radiofrequency neurotomy.

Original languageEnglish (US)
JournalPain Physician
Volume15
Issue number3
StatePublished - May 2012

Fingerprint

Sacroiliac Joint
Arthralgia
Steroids
Pain
Intra-Articular Injections
Botulinum Toxins
Outcome Assessment (Health Care)
Therapeutics
Lower Extremity
Injections
Return to Work
Information Storage and Retrieval
Bibliography
Advisory Committees
Low Back Pain
Local Anesthetics
PubMed
Opioid Analgesics
Observational Studies
Psychology

Keywords

  • Chronic low back pain
  • Pulsed radiofrequency
  • Sacroiliac joint dysfunction
  • Sacroiliac joint injection
  • Sacroiliac joint pain
  • Sacroiliitis
  • Thermal radiofrequency

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Hansen, H., Manchikanti, L., Simopoulos, T. T., Christo, P., Gupta, S., Smith, H. S., ... Cohen, S. (2012). A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician, 15(3).

A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. / Hansen, Hans; Manchikanti, Laxmaiah; Simopoulos, Thomas T.; Christo, Paul; Gupta, Sanjeeva; Smith, Howard S.; Hameed, Haroon; Cohen, Steven.

In: Pain Physician, Vol. 15, No. 3, 05.2012.

Research output: Contribution to journalArticle

Hansen, H, Manchikanti, L, Simopoulos, TT, Christo, P, Gupta, S, Smith, HS, Hameed, H & Cohen, S 2012, 'A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions', Pain Physician, vol. 15, no. 3.
Hansen H, Manchikanti L, Simopoulos TT, Christo P, Gupta S, Smith HS et al. A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2012 May;15(3).
Hansen, Hans ; Manchikanti, Laxmaiah ; Simopoulos, Thomas T. ; Christo, Paul ; Gupta, Sanjeeva ; Smith, Howard S. ; Hameed, Haroon ; Cohen, Steven. / A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. In: Pain Physician. 2012 ; Vol. 15, No. 3.
@article{a78e2bc419d546c281366cfa007d1012,
title = "A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions",
abstract = "Background: The contribution of the sacroiliac joint to low back and lower extremity pain has been a subject of debate with extensive research. It is generally accepted that approximately 10{\%} to 25{\%} of patients with persistent low back pain may have pain arising from the sacroiliac joints. In spite of this, there are currently no definite conservative, interventional, or surgical management options for managing sacroiliac joint pain. In addition, there continue to be significant variations in the application of various techniques as well as a paucity of literature. Study Design: A systematic review of therapeutic sacroiliac joint interventions. Objective: To evaluate the accuracy of therapeutic sacroiliac joint interventions. Methods: The available literature on therapeutic sacroiliac joint interventions in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized trials of interventional techniques and the criteria developed by the Newcastle-Ottawa Scale for observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature published from 1966 through December 2011 that was identified through searches of PubMed and EMBASE, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this systematic review, 56 studies were considered for inclusion. Of these, 45 studies were excluded and a total of 11 studies met inclusion criteria for methodological quality assessment with 6 randomized trials and 5 non-randomized studies. The evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain is fair. The evidence for effectiveness of intraarticular steroid injections is poor. The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is poor. The evidence for effectiveness of conventional radiofrequency neurotomy is poor. The evidence for pulsed radiofrequency is poor. Limitations: The limitations of this systematic review include a paucity of literature on therapeutic interventions, variations in technique, and variable diagnostic standards for sacroiliac joint pain. Conclusions: The evidence was fair in favor of cooled radiofrequency neurotomy and poor for shortterm and long-term relief from intraarticular steroid injections, periarticular injections with steroids or botulin toxin, pulsed radiofrequency, and conventional radiofrequency neurotomy.",
keywords = "Chronic low back pain, Pulsed radiofrequency, Sacroiliac joint dysfunction, Sacroiliac joint injection, Sacroiliac joint pain, Sacroiliitis, Thermal radiofrequency",
author = "Hans Hansen and Laxmaiah Manchikanti and Simopoulos, {Thomas T.} and Paul Christo and Sanjeeva Gupta and Smith, {Howard S.} and Haroon Hameed and Steven Cohen",
year = "2012",
month = "5",
language = "English (US)",
volume = "15",
journal = "Pain Physician",
issn = "1533-3159",
publisher = "Association of Pain Management Anesthesiologists",
number = "3",

}

TY - JOUR

T1 - A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions

AU - Hansen, Hans

AU - Manchikanti, Laxmaiah

AU - Simopoulos, Thomas T.

AU - Christo, Paul

AU - Gupta, Sanjeeva

AU - Smith, Howard S.

AU - Hameed, Haroon

AU - Cohen, Steven

PY - 2012/5

Y1 - 2012/5

N2 - Background: The contribution of the sacroiliac joint to low back and lower extremity pain has been a subject of debate with extensive research. It is generally accepted that approximately 10% to 25% of patients with persistent low back pain may have pain arising from the sacroiliac joints. In spite of this, there are currently no definite conservative, interventional, or surgical management options for managing sacroiliac joint pain. In addition, there continue to be significant variations in the application of various techniques as well as a paucity of literature. Study Design: A systematic review of therapeutic sacroiliac joint interventions. Objective: To evaluate the accuracy of therapeutic sacroiliac joint interventions. Methods: The available literature on therapeutic sacroiliac joint interventions in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized trials of interventional techniques and the criteria developed by the Newcastle-Ottawa Scale for observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature published from 1966 through December 2011 that was identified through searches of PubMed and EMBASE, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this systematic review, 56 studies were considered for inclusion. Of these, 45 studies were excluded and a total of 11 studies met inclusion criteria for methodological quality assessment with 6 randomized trials and 5 non-randomized studies. The evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain is fair. The evidence for effectiveness of intraarticular steroid injections is poor. The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is poor. The evidence for effectiveness of conventional radiofrequency neurotomy is poor. The evidence for pulsed radiofrequency is poor. Limitations: The limitations of this systematic review include a paucity of literature on therapeutic interventions, variations in technique, and variable diagnostic standards for sacroiliac joint pain. Conclusions: The evidence was fair in favor of cooled radiofrequency neurotomy and poor for shortterm and long-term relief from intraarticular steroid injections, periarticular injections with steroids or botulin toxin, pulsed radiofrequency, and conventional radiofrequency neurotomy.

AB - Background: The contribution of the sacroiliac joint to low back and lower extremity pain has been a subject of debate with extensive research. It is generally accepted that approximately 10% to 25% of patients with persistent low back pain may have pain arising from the sacroiliac joints. In spite of this, there are currently no definite conservative, interventional, or surgical management options for managing sacroiliac joint pain. In addition, there continue to be significant variations in the application of various techniques as well as a paucity of literature. Study Design: A systematic review of therapeutic sacroiliac joint interventions. Objective: To evaluate the accuracy of therapeutic sacroiliac joint interventions. Methods: The available literature on therapeutic sacroiliac joint interventions in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized trials of interventional techniques and the criteria developed by the Newcastle-Ottawa Scale for observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature published from 1966 through December 2011 that was identified through searches of PubMed and EMBASE, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this systematic review, 56 studies were considered for inclusion. Of these, 45 studies were excluded and a total of 11 studies met inclusion criteria for methodological quality assessment with 6 randomized trials and 5 non-randomized studies. The evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain is fair. The evidence for effectiveness of intraarticular steroid injections is poor. The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is poor. The evidence for effectiveness of conventional radiofrequency neurotomy is poor. The evidence for pulsed radiofrequency is poor. Limitations: The limitations of this systematic review include a paucity of literature on therapeutic interventions, variations in technique, and variable diagnostic standards for sacroiliac joint pain. Conclusions: The evidence was fair in favor of cooled radiofrequency neurotomy and poor for shortterm and long-term relief from intraarticular steroid injections, periarticular injections with steroids or botulin toxin, pulsed radiofrequency, and conventional radiofrequency neurotomy.

KW - Chronic low back pain

KW - Pulsed radiofrequency

KW - Sacroiliac joint dysfunction

KW - Sacroiliac joint injection

KW - Sacroiliac joint pain

KW - Sacroiliitis

KW - Thermal radiofrequency

UR - http://www.scopus.com/inward/record.url?scp=84861880909&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861880909&partnerID=8YFLogxK

M3 - Article

C2 - 22622913

AN - SCOPUS:84861880909

VL - 15

JO - Pain Physician

JF - Pain Physician

SN - 1533-3159

IS - 3

ER -